Log in. Interested in AAFP membership? Learn more. Zoorob is a graduate of the American University of Beirut and completed residency training in family practice at Anderson S. Memorial Hospital. Chandler Medical Center, Lexington. Address correspondence to Roger J. Zoorob, M. Reprints are not available from the authors. Drug facts and comparisons. Bethesda, Md. Gregerman RI. Metabolic and endocrine problems.
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Tuber Lung Dis. Effects of corticosteroids on intracranial pressure, computed tomographic findings, and clinical outcome in young children with tuberculous meningitis. This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference.
This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact afpserv aafp. Want to use this article elsewhere? Get Permissions. Read the Issue. Sign Up Now. Aug 01, Issue. A Different Look at Corticosteroids. Edema Decreased salt intake Increased potassium excretion Potassium supplements may be necessary.
Increased calcium excretion Use with caution in patients at increased risk of developing osteoporosis; calcium supplements may be necessary, especially in postmenopausal women.
Gastrointestinal Gastric irritation Take with meals to prevent gastric upset. Endocrine Hypercortisolism Cushingoid state , secondary adrenal insufficiency Associated with long-term use even at lower dosages Menstrual difficulties, including amenorrhea and postmenopausal bleeding Precipitation of diabetes mellitus Glucose intolerance, hyperglycemia In patients with diabetes, increased dosages of insulin or oral hypoglycemic agent and changes in diet should be expected.
Cardiovascular Hypertension Use with extreme caution in patients with recent myocardial infarction because of an apparent association with left ventricular free-wall rupture. Thromboembolism Use with caution in patients with thromboembolic disorders because of reports of rare increased blood coagulability. Thrombophlebitis CHF exacerbation Ocular Posterior subcapsular cataracts Prolonged use may result in increased intraocular pressure or damaged ocular nerve. Glaucoma May enhance secondary fungal or viral infections of the eye Musculoskeletal Muscle pain or weakness, muscle wasting, pathologic long bone or vertebral compression fractures, atrophy of protein matrix of bone, aseptic necrosis of femoral or humeral heads Use with caution in patients prone to development of osteoporosis; risk versus benefit should be reassessed if osteoporosis develops; elderly, debilitated or poorly nourished patients may be more prone to these effects.
Neuropsychiatric Headache, vertigo, seizures, increased motor activity, insomnia, mood changes, psychosis Use with caution in patients with convulsive or psychiatric disorders.
Other Increased susceptibility to infections, masked symptoms of infections Contraindicated in patients with systemic fungal infections except to control drug reactions associated with amphotericin B [Fungizone] therapy. Recommended tapering schedules Tapering the dosage over 2 months or more may be necessary for patients on prolonged treatment more than 1 year.
TABLE 3 Corticosteroids: Tapering Regimens and Withdrawal Symptoms Purpose of gradual withdrawal To allow recovery of normal pituitary-adrenal responsiveness to secretion of endogenous corticosteroid without exacerbating the underlying disease state. Read the full article. Get immediate access, anytime, anywhere. If withdrawal symptoms continue to bother you beyond a week, talk to your healthcare provider. In some cases, your healthcare provider may temporarily increase the dose and taper more slowly.
Some people may still have difficulty tapering off steroids despite reducing the dose by only 1 mg at a time. Another technique is known as an alternate-day taper. For example, instead of simply lowering the dose from 4 mg to 3 mg of prednisone, a healthcare provider may prescribe taking 4 mg one day and 3 mg the next day, then alternating back and forth for one week. Then, if that's successful, the healthcare provider may prescribe 4 mg one day and 2 mg the next, and so on until the patient is taking only 4 mg every other day for example, 4 mg one day and zero the next day.
The healthcare provider then continues to try to decrease that 4-mg dose. Tapering may not always prevent withdrawal symptoms. There are no tests to accurately predict who will experience withdrawal and to what degree. If your withdrawal symptoms are severe or last longer than seven days, call your healthcare provider, who can adjust the dose and slow the taper.
People on long-term prednisone therapy have the greatest risk for withdrawal. However, it can also occur in people who are only taking the steroid for a short period of time. In some cases, the tapering process may take weeks or several months.
Some healthcare providers will opt for a different corticosteroid than prednisone. These medications can have the same benefits with fewer side effects. A 5 mg dose of prednisone is equal to the following doses of other corticosteroids based on a corticosteroid conversion calculator :. Prednisone is a corticosteroid used to treat inflammation.
It mimics the stress hormone cortisol. When taken for extended periods, prednisone interferes with the body's natural production of cortisol. As a result, it is not recommended to stop prednisone abruptly. Doing so can cause body aches, fatigue, fever, and other uncomfortable withdrawal symptoms.
To minimize or prevent these withdrawal symptoms, your healthcare provider will instruct you how to taper off the steroid slowly. You may still experience uncomfortable symptoms for a few days when you taper. The amount of time it takes to taper off prednisone depends on many factors. These include the condition you're being treated for, the dose, and the duration of use. Eventually, your adrenal glands should return to their normal cortisol production levels, but this can take time.
There are many options available for discontinuing prednisone use. When low doses of corticosteroids are used for long periods, tapering can continue for months or years. Work closely with your healthcare provider to find the right taper for you.
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I Accept Show Purposes. Table of Contents View All. Table of Contents. Why Taper? How to Taper. What to Expect. Example of Prednisone Tapering Strategy Decrease dose by 5-milligrams mg at a time if the dosage is less than 40 mg per day. Decrease in 2. Decrease in 1-mg increments once a mg dose is reached.
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